Auto Glass Safety Council
385 Garrisonville Road, Suite 116
Stafford, VA 22554
540/602-3263; kbimber@agsc.org
ATTACHMENT B
ANSI/AGRSS 002-2002 - Automotive Glass Replacement Safety Standard
DECLARATION OF STANDARD CONFORMANCE
SELF ASSESSMENT
Company Name: __________________________________________ Date: ____________
Company Address: _____________________________________________________
______________________________________________________________________
Company FEIN #: ______________________________________________________
Is this a new AGSC Registration application or a renewal of an AGSC Registration application?
____ NEW APPLICATION: Proceed to page 2 (Section 3) and complete remainder of document
____ RENEWAL APPLICATION: Complete Section R-1: Registration Renewal below
SECTION R-1: RENEWAL DECLARATION
R:01
What adhesive manufacturer system are you currently using? ________________________
R:02
Is this the same system you were using when you originally registered with AGSC?
YES___
NO____
R:03
If YES, has the adhesive manufacturer‘s systems and system documentation stayed the same
since your last registration?
YES_____
NO____
If you answered YES to R:02 and R:03, please sign and date the form below and return along with your
payment to:
Auto Glass Safety Council
385 Garrisonville Road, Suite 116
Stafford, VA 22554
If you answered NO to either R:02 and/or R:03, please complete the remainder of this document.
____________________________________________________________________________________
The information on Attachment B is true and accurate to the best of my knowledge.
Signature: ____________________________________________________ Date: ________________
(Signed by company officer or owner)
Printed name: _______________________________________________________________________
SECTION 3: VEHICLE ASSESSMENT BEFORE REPLACEMENT
3.01 Do the personnel performing automotive glass replacement refrain from beginning
or completing an installation where any related condition would compromise the
retention system (examples may include, but not limited to, the following: rust,
contamination, suspect materials)?
□ Yes
□ No
3.02 In the event that such a compromised installation is apparent, are processes in
place and followed to notify the owner/operator of such a condition?
□ Yes
□ No
3.03 If such a condition has occurred, is documentation completed, kept on file and
available for review?
□ Yes
□ No
SECTION 3: CHECKING CONFORMANCE
 Check to make sure that:
 Inspections are completed to identify conditions outlined in Section 3, and that
no installation takes place when such conditions exist.
 The owner/operator is notified of such a condition.
 Documents noting such conditions are created and maintained.

DELIVERABLES:

3.0 Review the attached “DELIVERABLE CHECKLIST SHEET” and be sure these items are
submitted with this form to AGSC and are available for review during your validation audit.
SECTION 4: SELECTION OF GLASS AND RETENTION SYSTEMS
4.01 Have all the retention system suppliers/vendors that your functional units use,
been verified to ensure that their products are produced under a documented quality
assurance standard? (Example: ISO-900X, QS-9001, ISO-16949, other)
□ Yes
□ No
4.02 Has assurance been established that the glass products purchased for use by
your company meet the requirements of ANSI-Z26.1 as required by Federal Motor
Vehicle Safety Standard 205?
□ Yes
□ No
4.03 Is the retention system you are using OEM approved or equivalent and is
documentation available certifying this approval of equivalency?
□ Yes
□ No
4.04.1 Proper use of application materials?
□ Yes
□ No
4.04.2 Storage specifications?
□ Yes
□ No
4.04.3 Special requirements regarding adverse weather conditions?
□ Yes
□ No
4.05 If the documentation is available as stated in 4.04, has such documentation been
verified to be the most current revision available from the retention system
manufacturer or private labeler?
□ Yes
□ No
4.06 For products stored and accessible for use, have they been verified for being
within specified expiration dates and having printed and legible lot numbers?
□ Yes
□ No
4.04 Is documentation readily available from the retention system manufacturer or
private labeler that instructs users of such systems regarding all of the following criteria:
SECTION 4: CHECKING CONFORMANCE

Ask retention system manufacturer/private labeler to provide documentation verifying
their products as being produced under a quality assurance standard.

Ask retention system manufacturer/private labeler to provide record of products being
OEM approved or equivalent.

Ask retention system manufacturer/private labeler to provide current written
comprehensive instructions regarding proper use of application materials, storage
specifications, minimum drive-away time-containing temperature and humidity
variables and requirements regarding adverse weather conditions.

Make sure all auto glass technicians have such instructions readily available and that
such instructions are followed.

Check inventories to verify all products are within the specified expiration dates and
have printed, legible lot numbers.
DELIVERABLES:
4.01 During your validation review, have available a copy of the retention system
manufacturer/private labeler document that specifies compliance to quality assurance
standard.
4.03 Have available a retention system manufacturer/private labeler document that specifies
retention system being either OEM approved or equivalent.
4.04 Have available the original or photo-copy of the cover of retention system
manufacturer/private labeler’s current written instruction (entire booklet of written instructions
not required) that cover all points covered in section 4.04.
SECTION 5: INSTALLATION STANDARDS—ADHESIVE BONDED
□ Yes
5.01 Are all automotive glass replacements, either in-shop or mobile, completed in
accordance with the manufacturer’s/private labeler’s application instructions as stated in
4.05?
□ No
□ Yes
□ No
□ Yes
□ No
5.04 Are all vehicle owners/operators advised of minimum drive-away time under the
circumstances of the replacement?
□ Yes
□ No
5.05 Is the adhesive bead applied in such a manner that the profile and dimensions
meet or exceed the original equipment configuration?
□ Yes
□ No
□ Yes
□ No
5.02 Are all products stored and controlled according to the manufacturer’s/private
labeler’s requirements?
5.03 Are all automotive glass replacements, undertaken using an adhesive glass
retention bonding system, allowed to achieve minimum drive-away-time strength by the
time the vehicle may reasonably be expected to be operated?
5:06 Application questions regarding polyurethane, polysulfide, butyl, or other nonpolyurethane adhesive bonding systems:
5.06.01 In OEM polyurethane applications, is the glass replaced with
polyurethane or an equivalent bonding system?
5.06.02 If the OEM installations are butyl, polysulfide or other non-polyurethane □ Yes
and the vehicle is licensed for highway use, are all applications performed
using polyurethane or an equivalent retention system used (unless these are
applied in conflict with current OEM specifications)?
□ No
5.07 Are all adhesive system component lot numbers traceable to each job?
□ Yes
□ No
5.08 Are all glass parts DOT number and part number traceable to the installation?
□ Yes
□ No
5.09 Are all products used, subject to open shelf life, active shelf life and expiration
dates, controlled to prevent unintended usage?
□ Yes
□ No
5.10 Are all replacement supplemental mechanical glass retention devices replaced to
the original equipment specifications?
□ Yes
□ No
5.11 When installation personnel detect inappropriate replacement methods or
materials, is the owner/operator of the vehicle so notified?
□ Yes
□ No
5.12 Are all improper glass installations, caused by inappropriate replacement methods
or materials, corrected by using appropriate methods as described in Section 4.0?
□ Yes
□ No
5.13 When sealing air or water leaks within a polyurethane retention system, are
compatible polyurethane adhesives used (This equates to the NO silicones or butyls
are used)?
□ Yes
□ No
5.14 Is only the full cut method used in polyurethane retention system installations?
□ Yes
□ No
SECTION 5: CHECKING CONFORMANCE

Check to see that the following list of adhesive manufacturer/private labeler
instructions are followed:
 All automotive glass replacements completed in accordance to current
written instructions.
 All products stored in accordance to current written instructions.
 All automotive glass replacements allowed to achieve recommended driveaway times prior to being operated and vehicle owners/operators advised of
drive-away times.
 All products subject to shelf life, active shelf life and expiration dates are used
in accordance to written instructions.
 All installations completed using the full-cut method.
 All air or water leaks sealed with a compatible polyurethane adhesive when
working with a polyurethane retention system.
 All improper glass installations caused by inappropriate replacement methods
or materials are corrected according to written instructions and that the
owner/operator of the vehicle is notified.

Check to see that adhesive beads applied meet or exceed OEM profile and dimension
configuration.

Check to see that polyurethane and/or an equivalent bonding system is always used in
OEM polyurethane applications.

Check to see that all non-polyurethane OEM installations are performed using a
polyurethane and/or equivalent retention system, if the vehicle is licensed for highway
use and not in conflict with current OEM specifications.

Check to see that all adhesive system component lot numbers and glass part DOT/part
numbers are traceable to each job.

Check to see that all mechanical glass retention devices are replaced to original
equipment specifications.
DELIVERABLES:
5.03 During your validation review, have available a copy of the drive-away time chart provided
by the retention system manufacturer/private labeler.
5.04 Have available a copy of the record utilized to record drive-away times specified to the
vehicle owner/operator.
5.07 Have available a copy or the record utilized to note retentions system lot numbers and
glass part DOT/part numbers.
SECTION 6: INSTALLATION STANDARDS—RUBBER GASKET
6.01 In OEM installations where a combination of a rubber gasket and polyurethane is
used in a retention system, is an equivalent adhesive bonding system used in all such
replacements?
□ Yes
□ No
6.02 In OEM gasket installations where the OEM did not include polyurethane or an
equivalent adhesive system, is polyurethane or an equivalent adhesive bonding system
used, even if later production models included the addition of adhesive systems without
vehicle body style modifications?
□ Yes
□ No
6.03 Do all installations where the OEM gasket installation does not include adhesive
and the vehicle is licensed for highway use, include polyurethane or an equivalent
adhesive bonding system?
□ Yes
□ No
6.04 When sealing air or water leaks within a rubber gasket/polyurethane ADHESIVE
SYSTEM, is only compatible polyurethane used?
□ Yes
□ No
6.05 When sealing air or water leaks within a rubber gasket SEALANT SYSTEM, is only □ Yes
OEM compatible sealant used?
□ No
SECTION 6: CHECKING CONFORMANCE

Check to see that all gasket set installations and sealing for air or water leaks comply
with each of the stated 6.01 through 6.05 points of this section.
SECTION 7: ADDITIONAL REQUIREMENTS
7.01 During all mechanically-fastened automotive installations, are parts replaced only
according to original equipment specifications?
□ Yes
□ No
7.02 When glass parts are installed in vehicles licensed for highway use, including
custom cut parts, are they marked in compliance with the certification requirements
specified in FMVSS 205 and the marking requirements of ANSI Z26.1?
□ Yes
□ No
7.03 When internal or external mirrors are replaced, do these parts meet or exceed
original equipment specifications and the requirements of FMVSS 111?
□ Yes
□ No
7.04 Whenever OEM retention systems are modified on later production models without □ Yes
body style modifications, is only the most current retention system used in the
replacement unless otherwise stated by the OEM?
□ No
7.05 Do you have a system in place that allows reporting directly to the manufacturer or □ Yes
product supplier of products that the installer believes could jeopardize customer
safety?
□ No
7.06 In instances as described in 7.05, are records kept of such notification and product □ Yes
deficiency?
□ No
7.07 Are there policies and controls in place preventing the use of materials that could
adversely affect the glass retention system, including but not limited to, cleaners,
release agents, solvents and lubricants?
□ Yes
□ No
7.08 Are there policies and controls in place that prevent any installation practice that
could adversely affect the glass retention system?
□ Yes
□ No
7.09 Are documents maintained to demonstrate compliance with ANSI/AGRSS 0022002?
□ Yes
□ No
SECTION 7: CHECKING CONFORMANCE

Check to see that technicians are equipped with proper training and follow proper
guidelines for replacing all mechanically-fastened parts according to OEM
specifications.

Check to see that all glass parts and mirrors are compliant with FMVSS 205/ANSI Z26.1
and FMVSS 111 respectively and that glass parts are marked for such compliance.

Check to see that the most current retention system is used whenever OEM retention
systems are modified on later production models without body style modification.

Check to see that you have a system in place to report to the manufacturer or supplier
of products if their products may jeopardize customer safety.

Check to see that you have policies and controls in place that prevent the use of
materials or installation practices that could adversely affect the glass retention
system.

Check to see that you maintain documents, such as the mentioned deliverables within
this registration packet and a properly completed registration, that demonstrate your
compliance with ANSI/AGRSS 002-2002.
SECTION 8: EDUCATION
8.01 Are all technicians, performing replacement of automotive glass fully qualified for
the tasks they are required to perform (note: qualifications shall include, at a MINIMUM,
completion of a comprehensive training program with a final exam and a continuing
education component)?
□ Yes
□ No
8.01.1 Does the training program include AGR Safety issues?
□ Yes
□ No
8.01.2 Does the training program include understanding of OEM installation
standards and practices?
□ Yes
□ No
8.01.3 Does the training program include relevant technical specifications?
□ Yes
□ No
8.01.4 Does the training program include comprehensive retention specific
training?
□ Yes
□ No
8.01.5 Does the training program include the opportunity to apply and
demonstrate the skills learned?
□ Yes
□ No
□ Yes
□ No
8.02 Are records maintained that demonstrate compliance with 8.01?
SECTION 8: CHECKING CONFORMANCE

Check to see that all personnel performing auto glass replacement are current with
completion of a qualified training program that includes, but is not limited to, points
8.01.1 through 8.01.5.

Check to see that records are maintained to demonstrate each person’s completion of
the training specified within section 8.
DELIVERABLES:
8.02 During your validation review, have available a sample copy of AGR-related training
certificate of employed auto glass technicians indicating form of training maintained.
DECLARATION OF CONFORMANCE TO ANSI/AGRSS 002-2002
Company Name:_____________________________________________________
Person Completing Registration:_______________________________________
Title: ______________________________________________________________
The information in Attachment B is true and accurate to the best of my knowledge.
Signature: _______________________________________ Date: _____________
(Signed by company officer or owner)
Auto Glass Safety Council
385 Garrisonville Road, Suite 116
Stafford, VA 22554
540/602-3263; kbimber@agsc.org
DELIVERABLES CHECK LIST
The following is a list of the items that need to be submitted with this Attachment BDeclaration of Standard Conformance in application to become an AGSC Registered
Member company. You will also need to have copies of these items available during
your validation audit.
DELIVERABLE 1:
3.0 Copy of form used to record conditions of vehicle that could compromise the retention system.
DELIVERABLE 2:
4.01 Copy of the retention system manufacturer/private labeler document that specifies compliance to
a quality assurance standard.
DELIVERABLE 3:
4.03 Copy of the retention system manufacturer/private labeler document that specifies retention
system being either OEM approved or equivalent.
DELIVERABLE 4:
4.04 Copy of cover of retention system manufacturer/private labeler current written instructions.
DELIVERABLE 5:
5.03 Copy of drive-away time chart provided by retention system manufacturer/private labeler.
DELIVERABLE 6:
5.04 Copy of your shop’s record utilized to record drive-away times specified to the vehicle
owner/operator (make sure names of owner/operator do not appear).
DELIVERABLE 7:
5.07 Copy of your shop’s record utilized to note retention system lot numbers and glass part DOT/part
numbers (make sure names of owner/operator do not appear).
DELIVERABLE 8:
8.02 Copy of AGR-related training certificate of personnel performing auto glass replacement
indicating form of training maintained.